Abstract

Introduction

Intracranial pressure monitoring is commonly implemented in patients with neurologic
injury and at high risk of developing intracranial hypertension, to detect changes
in intracranial pressure in a timely manner. This enables early and potentially life-saving
treatment of intracranial hypertension.

Case presentation

An intraparenchymal pressure probe was placed in the hemisphere contralateral to a
large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically
ventilated and sedated because of depressed consciousness. Intracranial pressures
were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped,
our patient showed clinical signs of transtentorial brain herniation, despite apparently
normal intracranial pressures (less than 10 mmHg). Computed tomography revealed that
the size of the intracerebral hematoma had increased together with significant unilateral
brain edema and transtentorial herniation. The contralateral hemisphere where the
intraparenchymal pressure probe was placed appeared normal. Our patient underwent
emergency decompressive craniotomy and was tracheotomized early, but did not completely
recover.

Conclusions

Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral
hematoma may dramatically underestimate intracranial pressure despite apparently normal
values, even in the case of transtentorial brain herniation.